Organization
411 HELP II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAJIR WUTWUT (PRACTICE MANAGER)
(313) 899-0498
Entity
Organization
Contact information
Practice address
27207 LAHSER RD STE 106, SOUTHFIELD, MI 48034-2168
(313) 899-0498
Mailing address
PO BOX 7485, DEARBORN, MI 48121-7485
(313) 899-0498
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501004726
PHYSICAL THERAPY
MI
Enumeration date
05/15/2019
Last updated
05/15/2019
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